Shared Flashcard Set

Details

Glaucoma-Lingel
Exam 1
120
Medical
Graduate
10/06/2013

Additional Medical Flashcards

 


 

Cards

Term
2 most important factors in diagnosis of glaucoma
Definition
1. Risk Factors
2. Appearance of nerve head
Term
Name 1 common risk factor present in all participants in the OHTS study
Definition
All had ocular hypertension
Term
Why was the use of oral calcium channel blockers considered in the OHTS study
Definition
Calcium channel blockers can cause dilation of blood vessels in the periphery and are thought to be protective in glaucoma
Term
Investigation of what risk factor was added later in the OHTS study
Definition
Central Corneal Thickness
Term
Name 4 multivariant risk factors found to be significant according to the OHTS study
Definition
Age (per decade)
Vertical cup to disc ratio
IOP
Pattern Standard Deviation
Term
Name 3 univariant risk factors found to be signficant according to the OHTS study
Definition
Gender (Male)
Self-identified race
Heart disease
Term
Is myopia a risk factor for glaucoma supported by the OHTS study
Definition
No, it is not supported by the OHTS study
Term
Which of the following is a supported risk factor for glaucoma according to the OHTS study
Migraine
Blood Pressure
Vertical CD
Diabetes
Definition
Vertical CD
Term
Family history was shown to be a risk factor in glaucoma, order the following relation from greatest to least risk
Maternal, Sibling, Paternal
Definition
Sibling>Maternal>Paternal
Term
Why may the OHTS study findings regarding the relation between POAG and DM differ from all other studies
Definition
Possibly because OHTS excluded patients with DR and the patient group was not representative of DM
Term
What 2 characteristics of a patients fingernails may increase their risk of glaucoma
Definition
Hemorrhages underneath nails increases risk of glaucoma
Avascularity of nailfold capillary bed
Term
Low blood pressure is more likely to be related to which form of glaucoma
Definition
Normo-tensive glaucoma
Term
1 reason why the OHTS showed no correlation between glaucoma and myopia, unlike other studies have shown
Definition
OHTS participants had low average refractive errors, thus high myopes were not properly represented in the study
Term
The results of the OHTS study should only be applied to individuals with an IOP of:
Definition
24-32 mmHg
Term
The results of the OHTS study should only be applied to individuals between the ages of ______________
Definition
40-80 years old
Term
Describe a specific subset of women who are more likely to develop the glauc!
Definition
Thin, Thirst (don't respond to thirst well) and Cold feet
Term
Name a condition that may be a vascular marker for glaucoma in men and is associated with a 3X risk of glc
Definition
Erectile Dysfunction
Term
How may cataracts relate to the development of glaucoma
Definition
As the lens swells due to cataracts the angle becomes narrower, which can cause angle closure
Term
Tests that have low numbers of false positives have high ________________ (sensitivity or specificity)
Definition
High Specificity
Term
Tests that have low numbers of false negatives have high ________________ (sensitivity or specificity)
Definition
High Sensitivity
Term
3 Goals of Testing for Glaucoma
Definition
High Specificity
High Sensitivity
Repeatable and valid results
Term
Which test for glaucoma has the best specificity
Definition
IOP (99%)
Term
Which test for glaucoma has the lowest sensitivity
Definition
Tono IOP using the cutoff of 24mmHg
Term
How can we increase the sensitivity and specificity of testing for glaucoma
Definition
Increase the number of tests performed
Term
How do we designate a pt (suspect or confirmed case) who has high IOP, large cupping but not VF loss or ONH change
Definition
Suspect/Ocular HTN
Term
What testing time indicates abnormal FDT
Definition
Longer than 90s on one eye
Term
In the central 5 locations on an FDt, what indicates an abnormal result
Definition
Any defect at all in the central 5 locations
Term
In the outer twelve locations on an FDT, what indicates an abnormal result
Definition
2+ mild defects, 1+ moderate/severe defects
Term
Fixation losses on Humphrey VF
What does upward line indicate?
Definition
Fixation Deviation
Term
Fixation losses on Humphrey VF
What does downward line indicate?
Definition
Blink or unable to track fixation
Term
_____% or less errors in blind spot testing on a visual field indicates a reliable field
Definition
20% or less
Term
_____% or less false positives/negatives on a visual field indicates a reliable field
Definition
33% or less
Term
Which part of the visual field print out compares corresponding data points above and below the horizontal midline
Definition
Glaucoma Hemifield Test
Term
Everything except _____________ on a visual field printout is adjusted for age matched norms
Definition
Raw Data Display
Term
Single Field Printout Analysis
Area that illustrates difference between expected for age and achieved (- means less sensitive)
Definition
Total Deviation
Term
Single Field Printout Analysis
Plot that illustrates how likely the pattern deviation is due to chance or real
Definition
Probability plot of Pattern deviation
Term
Which part of the single field printout analysis for visual fields is most indicative of risk of glaucoma, according to OHTS
Definition
Pattern Deviation
Term
4 Most common types of early field loss in glaucoma
Definition
Partial Arcuate
Paracentral
Nasal Step
Temporal wedge
Term
Most common location for paracentral scotoma to occur due to glaucoma
Definition
Superior temporal
Term
2 ways the appearance of the disc can be used to differentiate glaucoma from AION
Definition
Pallor in AION, not as likely in glaucoma
Excavation in glaucoma, not AION
Term
Which glaucoma patients are more likely to have generalized VF depression (compared to localized defects), those with high IOP or low IOP
Definition
Those with generalized depression tend to have higher IOP than those with localized defects
Term
What CPSD value indicates the VF defects are significant?
Definition
<5% of normal
Term
The thickness/stability of the cornea relates to the thickness/stability of the ___________ ____________since they have similar structural makeup
Definition
Lamina cribrosa
Term
Those with Ocular Hypertension tend to have ________________ corneas
Definition
Thicker
Term
Those with Normotensive Glaucoma tend to have ______________ corneas
Definition
Thinner
Term
Performing gonioscopy before tonometry can cause the measurements to be _______________
Definition
Lower
Term
Performing a visual field may ______________ tonometry readings (if taken close together)
Definition
Increase IOP readings
Term
Narrow anterior chamber angles tend to have ____________ iris approaches
Definition
Convex
Term
Name 4 nerve head characteristics that can influence whether or not it follows the ISNT rule
Definition
Location of ONH
Tilting
Irregular shape
Drusen
Term
Normal size of an optic nerve head
Definition
1.3-2.5mm
Term
How many fibers in normal optic nerve head
Definition
1.2 million
Term
Ganglion cell axons are usually first to go from which areas of the disc
Definition
Superior and inferior, especially inf temp
Term
It is normal to have a slightly vertically elongated ________ but not normal to have a vertically elongated _______
Definition
Normal for disc to be V>H, but not for cup (only 7% of normals have it)
Term
If using the size of major veins to judge the size of the nerve head, you should be able to 'fit' _____ into the nerve head
Definition
Fit 12 major vessels in
Term
Most common position of central retinal artery trunk
Definition
Superior nasal
Term
Area in which we expect to first see rim tissue loss is furthest from____________
Definition
Central Retinal Artery Trunk
Term
3 aspects of vessel evaluation in glaucoma
Definition
1. Position of CRA trunk
2. Diffuse arteriolar narrowing
3. Shift in vessel position
Term
Approximately how long for an optic disc hemorrhage to resolve
Definition
10 weeks
Term
What other evidence of progressing glaucoma is associated with rim notching
Definition
Splinter heme
Term
2 zones of peripapillary pigmentary atrophy, which is more concerning
Definition
Beta is more concerning, if alpha is present but alone there is not as much concern.
Term
Alpha and Beta atrophy- which is always closest to the disc and which is the leading edge?
Definition
Beta always closest to nerve head and alpha is the leading edge
Term
Beta zone peripapillary atrophy is atrophy of which layers
Definition
Rpe/Choriocapillaris
Term
What may be the first sign of glaucoma in a crowded nerve head where it is difficult to see nerve loss
Definition
Presence of beta atrophy
Term
Describe alpha zone peripapillary atrophy
Definition
Mottled appearance of RPE around the disc, irregular hyper and hypo pigmentation
Term
ONH Pits are most common in which part of the disc
Definition
Inferior Temporal quadrant
Term
The brightness of the nerve fiber layer correlates to it's _____________
Definition
Thickness
Term
With advanced glaucoma, which region of the nerve fiber layer may appear to be brightest (reversed pattern)
Definition
Papillomacular area becomes brightest instead of near disc
Term
Which ethniticites have a higher rate of conversion from Ocular Hypertension to Glaucoma
Definition
African Americans
Term
In the Ocular HTN Treatment study, what was found to be the most common first indication of glaucoma
Definition
ONH changes
Term
In the Ocular HTN Treatment study, what was found to be the second set of changes that indicate glaucoma
Definition
Visual Field loss
Term
Early Management Glaucoma Trial found what difference in treated vs. untreated groups
Definition
Progression in 45% of treated and 62% of untreated
Faster progressionin untreated
Term
In the EMGT what was the most significant side effect in treated patients
Definition
Increased incidence of nuclear cataracts
Term
What did the AGIS study find in regards to stability of IOP and the relation to glaucoma progression
Definition
Eyes <18 mmHg at all visits had almost completely stable VF
Eyes whose IOP fluctuated at 50% of visits had definite worsening of VF
Term
5 recommendations for when to begin treating glaucoma
Definition
IOP>30mmHg
Changes in ONH, NFL or VF consistent with glaucoma and each other
Patient request
Vascular disease changes (heme)
Risk factors outweigh equivocal findings
Term
AOA Stages of POAG
Description of Optic Nerve in the MILD category
Definition
Mild concentric narrowing of rim
Disc hemorrhage
Asymmetry
Term
AOA Stages of POAG
Description of Optic Nerve in the MODERATE category
Definition
Moderate concentric narrowing
Increased central pallor
Loss of rim in 1 quadrant
Focal notching
Vessel undermining
Term
AOA Stages of POAG
Description of NFL in Mild vs. Moderate category
Definition
Mild-less striations, large vessels clear, med and small bvs blurred
Moderate-no texture and all vessels clear
Term
AOA Stages of POAG
Visual field changes in Mild vs. Moderate category
Definition
MILD- Isolated paracentral scotomas, partial arcuate or nasal step
Damage in only 1 hemifield, <25% points involved
MD <6dB
MODERATE-Partial or FULL arcuate scotoma, damage may involved both hemifields but no fixation
MD-6 to -12 dB
Term
Description of Optic Nerve in SEVERE category
Definition
Complete absence of rim in at least 3 quadrants
Bayonetting
Increased central disc pallor
Term
AOA Stages of POAG
Description of NFL in Moderate vs. Severe category
Definition
MODERATE-minimal brightness, no texture, all vessels clear
SEVERE-Dark reflex, no texture, all vessels clear
Term
AOA Stages of POAG
Visual fields in SEVERE category
Definition
Advanced loss in BOTH hemifields
MD<12dB, fixation may be involved.
Term
Mild Glaucoma Stage according to Medicare
Definition
ONH abnormalities consistent with glaucoma w/o VF loss
Term
Moderate Glaucoma stage according to Medicare
Definition
ONH abnormalities consistent with glaucoma w/ VF loss in 1 hemifield and not within 5 degrees of fixation
Term
Severe (ie. advanced or endstage) Glaucoma according to Medicare
Definition
ONH abnormalities consistent with glaucoma, VF loss in both hemifields and/or loss within 5 degrees of fixation
Term
According to evidence based studies, how much do you aim to decrease IOP by when they have Ocular HTN and risk factors present
Definition
Decrease by 20%
Term
According to evidence based studies, how much do you aim to decrease IOP by when they have VF loss or ONH notching
Definition
by 30-35%
Term
According to evidence based studies, how much do you aim to decrease IOP by when they have extreme VF loss and/or cupping
Definition
by 50%
Term
According to AOA guidelines, how much do you aim to lower IOP by when they have Ocular HTN
Definition
20% less than baseline and <20mmHg
Term
According to AOA guidelines, how much do you aim to lower IOP by when they have mild glaucoma
Definition
20-30% less than baseline
Term
According to AOA guidelines, how much do you aim to lower IOP by when they have advanced glaucoma
Definition
40% less than baseline and <15 mmHg
Term
According to AOA guidelines, how much do you aim to lower IOP by when they have normotensive glaucoma
Definition
30% less than baseline
Term
How much do you lower IOP by for any glaucoma patient according to Cole/Lewis
Definition
Decrease by the percentage equal to their initial IOP (ie. IOP =20mmHg, decrease by 20%)
Term
Formula for target IOP according to Jampel
Definition
Target=Max IOP-Max IOP% -Z
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=0
Definition
0= normal ONH and VF
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=1
Definition
1=Abnormal disc and normal VF
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
When does Z=2
Definition
2= VF loss NOT threatening fixation
Term
For Jampel Target IOP formula, Z= optic nerve damage severity factor
when does Z=3
Definition
3= VF loss threatening or involving fixation
Term
Formula for target IOP according to Hartelben
Definition
Target=IOP-IOP%-MD on VF
Term
Which recommendation for target IOP represents the most aggressive 'calculation'
Definition
Hartelben, the one that subtracts MD
Term
No matter what target IOP you set, you will need to constantly ________________________
Definition
Re-evaluate it
Term
Who owns the technology for Stratus OCT
Definition
Zeiss-no other companies can make them
Term
Which company owns the SD-OCT
Definition
not owned by 1 company, is made by different manufacturers
Term
For Cirrus OCT database, what is the youngest age included in the normative database
Definition
19yo
Term
Name the parameters that the normative databases of the RNFL and Macula are adjusted for with the Cirrus OCT
Definition
Age only, no other parameters
Term
Name 3 parameters that normative database is adjusted for in the RTVue
Definition

Age

Disc size

Signal strength

Term
For Cirrus OCT, which parameters are used when applying normative limits to ONH parameters
Definition

Age

Optic Disc Area

Term
What does the FAstrac technology do in the Cirrus OCT
Definition
It overlaps the BV each scan to ensure the exact same area is being analyzed each time,s othe comparisons are more reliable.
Term
What anatomic features does the Cirrus use to identify the end of the cup
Definition
Bruch's membrane termination
Term
How many baseline scans are needed for Cirrus OCT
Definition
2 baseline
Term
Approx how does the rate of glaucoma progression change when the pt presents with a Drance hemorrhage
Definition
Increases about 2X
Term
What layers of the retina make up the ganglion cell complex
Definition

Nerve Fiber Layer (axons)

Ganglion Cell Layer (cell bodies)

Inner Plexiform Layer (dendrites)

Term
Where is the ganglion cell complex thickest
Definition
Macula
Term
Of the three layers within the GCC, which has normal variation between individuals, and which tends to be constant between normal individuals
Definition

RNFL varies between individuals

NFL and IPL appears more similar b/w individuals

Term
Describe Ganglion Cell Analysis
Definition
It analyzes 2/3 layers of the GCC, it removes the RNFL from the equation since there is so much variability between individuals.
Term

True or False

The Heidelberg Spectralis has eye tracking technology like the FAstrac on Cirrus

Definition
True
Term
Which instrument has the unique feature, Fovea to Disc Alignment
Definition

Spectralis-which eliminates head tilt as a contaminating factor, therefore it accounts for both eye movement and head positioning.

Cirrus does not do this, only eye movement

Term
Which OCT makes a comparison between the 2 eyes as well as between superior and inferior in one eye
Definition
Spectralis-Posterior Pole Symmetry Index
Term
How many baseline scans are needed for Spectralis vs. Cirrus
Definition

Cirrus=2 (may change now that they have Fastrac)

Spectralis=1 

Term
Which 2 types of perimetry are done by the Spectralis and it's HEP attachment
Definition

Flicker Defined Form for early glaucoma

Standard Automated Perimetry for mod-severe progressive disease

Term
Which OCT has the best GCC analysis
Definition
RTVue
Supporting users have an ad free experience!